Life Sciences

Achieving better quality with less money

Medicare & Reimbursement Advisor Weekly, June 10, 2009

Maybe it’s the fact that access to doctors is down. Maybe it’s that the economy has hurt sales for many drugs, particularly those for chronic conditions. Or maybe it’s the heightening restrictions managed care and Medicare are putting in place as they try to figure out how to pay for all pharmaceutical therapy. Whatever it is, more and more managed markets, research, and brands are turning their attention to nontraditional segments—especially hospitals. More and more of you are trying to find opportunities for account sales teams to talk to health system leaders and understand what keeps hospitals up at night, how and when hospitals generate scripts, how quality and C-suite directors influence pharmacy decisions, and, above all, the power of the script that starts with a hospitalist and a discharge plan.

With this in mind, here’s some insight from the HealthLeaders hospital quality department (the full article appears at

Eleven process measures provided at least 25 observations for a majority of hospitals in a recent Health Affairs study: aspirin at arrival and discharge and beta-blocker prescription at arrival and discharge (for AMI); assessment of left ventricular function, provision of discharge instructions, and angiotensin converter enzyme inhibitor or angiotensin receptor blocker prescription for patients with left ventricular systolic dysfunction (congestive heart failure); blood culture performed before receiving the first antibiotic in the hospital, first dose of antibiotic within four hours of admission, initial antibiotic selected appropriately, and assessment of arterial oxygenation within 24 hours of arrival (pneumonia).

The researchers constructed a measure of spending that reflected only the specific use of services to explain a large amount of hospital spending: number of hospital days, total physician visits, ICU days, and the ratio of specialist to primary care physician visits at the end of life. (This means that the influence of varying reimbursements linked to graduate medical education, Medicare disproportionate share payments, and geographical price adjustments were removed.)

What they found after all this is that by examining process of care measures, hospitals that provide more intensive and costly care do not necessarily provide better quality care, as measured by the percentage of patients who are given evidence-based treatments.

Source: MRAW correspondent Janice Simmons.